| NPI | 1790025559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: MN 62508) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: MD D91147) |
| Enumeration Date | 2013-02-15 |
| Last Update Date | 2022-08-03 |